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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 48 to 72 of 72. Go back in thread:
Posted by morgan miller on July 18, 2010, at 15:00:35
In reply to Re: You hangin in there peanut? » ed_uk2010, posted by inanimate peanut on July 18, 2010, at 12:55:09
Do you think the perphenazine is really helping you sleep? If stopping it might alleviate your depression and you think you could find other more effective ways to treat your insomnia with less side effects, wouldn't it be worth it to drop it from the huge load of meds you are taking? What do you think is more important right now, your depression or your insomnia? I guess if you don't sleep for long enough it can start to make you more depressed. There seems to be a bit of a catch 22 going on here.
Sorry you're struggling with this. I have a feeling things will get better over the next few months. Definitely find a good doc and work hard with them to resolve some of these issues. Good luck!
Morgan
Posted by inanimate peanut on July 18, 2010, at 15:00:59
In reply to Lou's reply-hileighdaynguruz, posted by Lou Pilder on July 18, 2010, at 14:53:26
I really do appreciate your concerns. I'm aware of the risks. I take my BP so often that my arm looks like I stuck it through a tunnel of nails. Both my BP and temperature have remained rock solid. Clinical worsening is always a risk and is what I'm dealing with now possibly. I've had no suicidal thoughts but promise to go to the hospital if I do.
Posted by inanimate peanut on July 18, 2010, at 15:03:53
In reply to Re: You hangin in there peanut?, posted by morgan miller on July 18, 2010, at 15:00:35
Thanks Morgan. I tried to balance the depressive effects of the perphenazine by taking only 8mg of it. It is a hard choice between sleep and feeling a bit more depressed (not huge difference). I'm seriously considering trying to sleep with the lunesta alone and seeing what happens.
Posted by Lou Pilder on July 18, 2010, at 15:04:48
In reply to Lou's reply-hileighdaynguruz, posted by Lou Pilder on July 18, 2010, at 14:53:26
> > inanimate peanut,
> > I heave read such reports and there are different camps in relation to taking the two classes of drugs together.
> >
> > I lean to the camp that says that the two taken together could be very dangerous. In your situation, there are also other drugs being combined that are central nervous system depressants which brings in that the reports that you cited were taking the two classes of drugs together without consideration as to if a CNS-depressant was added. I also do not consider those type of reports to be significant because of the small population used. I give credence when the population is in the thousands.
> > Here is a link to an article and there is the list of classes of drugs that are dangerous when combined with the other class.
> > Lou
> > http://bipolar.about.com/od/maois/a/maois_profile.htm
>
> inanimate peanut.
> Here is a link to an article concering the danger of combining the two classes of drugs. I would like if you read it to look at 4.4 (Contra-idications and 4.4 (special warnings) that include suicide and suicidal thoughtss and clinical worsening.
> There is what is called hypertensive crisis which also is a dangerous possibility when taking both of the drugs together.
> Lou
> http://www/goldshield-pharmaceuticals.com/csp/gsh/pharma/pdf/spc/42/3.pdfcorrection:
Lou
http://www.goldshield-pharmaceuticals.com/csp/gsh/pharma/pdf/spc/42/3.pdf
Posted by morgan miller on July 18, 2010, at 15:04:52
In reply to Re: You hangin in there peanut? » ed_uk2010, posted by inanimate peanut on July 18, 2010, at 14:15:55
I think you should keep going back to lithium to see if it will work again. Just because it did not work the last time you went back to it does not mean it will not work again for you. It doesn't have to work magic. A small dose like 300 mg may do something subtle but good enough to justify staying on it as an adjunct.
Posted by morgan miller on July 18, 2010, at 15:09:13
In reply to Re: You hangin in there peanut? » morgan miller, posted by inanimate peanut on July 18, 2010, at 15:03:53
> Thanks Morgan. I tried to balance the depressive effects of the perphenazine by taking only 8mg of it. It is a hard choice between sleep and feeling a bit more depressed (not huge difference). I'm seriously considering trying to sleep with the lunesta alone and seeing what happens.
Good luck!
I totally support you in your attempt with Nortriptyline. I think Lou means well but I believe he is anti-med and is quite biased against any kind of experimentation or going outside convention. I think he needs to leave it alone now and accept that you are going to do what you are going to do.
Posted by jade k on July 18, 2010, at 15:20:28
In reply to Re: You hangin in there peanut?, posted by jade k on July 17, 2010, at 19:39:07
Hey peanut,
So, looks like you are hanging in there. The following is part of one of Lou's links. Just keep it handy. I'll check the other links as well. Not trying to scare you, just think you should know exactly what to look for.
Danger Signals
Stop taking your MAOI and get emergency help immediately if you experience any of the following symptoms of a hypertensive crisis:Severe chest pain; severe headache; stiff or sore neck; enlarged pupils; fast or slow heartbeat; increased sensitivity of eyes to light; increased sweating (possibly with fever or cold, clammy skin); nausea and vomiting.
You'll probably be fine, but watch for these and get help if you need it.
~Jade
Posted by inanimate peanut on July 18, 2010, at 15:35:23
In reply to Re: You hangin in there peanut?, posted by morgan miller on July 18, 2010, at 15:09:13
Thanks-- i was starting to feel a little beat up (not just Lou but in general). Not that I don't appreciate people caring, because I do. But it's good to have someone in support of peanut... :-)
Posted by jade k on July 18, 2010, at 15:44:15
In reply to Re: You hangin in there peanut?, posted by jade k on July 18, 2010, at 15:20:28
peanut,
I didn't find anything else that hasn't already been covered in terms of what to watch for...just remember these things also:
-Drink plenty of water
-Remember the food list, if your tired you may forget.
-Are you eating? Eat a little if you can, even if you aren't hungry.
-Please don't increase your Parn or Nort, even if you start to feel bad.
-Just a suggestion, make a comprehensive list of all that you have, and are taking, just in case you end up at ER or Docs office. If you get a hypertensive headache (ouch) believe me you won't do it. Many med facilities are unfamiliar with MAOI's and particularly their use with tca's.Good to be prepared, let me know if you need a new restricted food list.
~Jade
Posted by jade k on July 18, 2010, at 15:52:11
In reply to Re: You hangin in there peanut?, posted by jade k on July 18, 2010, at 15:44:15
What??!!
We're all in support of you peanut! We're also in support of you being safe. And being depression free. In that order :-)~Jade
Posted by inanimate peanut on July 18, 2010, at 16:07:58
In reply to Re: You hangin in there peanut?, posted by jade k on July 18, 2010, at 15:44:15
Posted by ed_uk2010 on July 18, 2010, at 16:09:21
In reply to Re: You hangin in there peanut? » ed_uk2010, posted by inanimate peanut on July 18, 2010, at 14:57:42
>If the nortriptyline didn't work out, I was going to try lithium again. I had always been on lithium carbonate, but I wonder if my body will view lithium citrate as a "different drug" and thus allow it to work.
It shouldn't make any difference whether you take the carbonate salt or the citrate salt. Only the lithium ion itself has activity on the central nervous system. Different brands of lithium tablets have varying release characteristics, but this is due to different 'slow release' technology being used, not due to the lithium salt itself.
>I don't think the perphenazine is making me cry, because I've been on it for several months now and the crying is brand new.
It could be the high doses of sedatives taken at night. Crying has been reported as a side effect of high dose Ativan, for example.
Posted by Roslynn on July 18, 2010, at 16:59:19
In reply to Re: You hangin in there peanut?, posted by jade k on July 18, 2010, at 15:44:15
Jade,
I'm sorry to bother you, but do you know of a good restricted food list? I am seeing contradictions in some various lists. I think I am starting Parnate soon.
Thank you!
Roslynn
>
> Good to be prepared, let me know if you need a new restricted food list.
>
> ~Jade
>
Posted by nadezda on July 18, 2010, at 17:20:11
In reply to Re: Lou's reply, posted by inanimate peanut on July 18, 2010, at 12:40:46
Could you please refer me to these articles, becaue I can't find them.
thanks,
Posted by jade k on July 18, 2010, at 17:57:58
In reply to Re: You hangin in there peanut? » jade k, posted by Roslynn on July 18, 2010, at 16:59:19
Hi Roslynn,
No bother, I'd be happy to. I'll post it back to you in a bit. These lists have been posted many times and I'll want the best one. The restrictions are much simpler than a lot of sights still post.
~Jade
Posted by inanimate peanut on July 18, 2010, at 19:45:43
In reply to Re: To Roslynn » Roslynn, posted by jade k on July 18, 2010, at 17:57:58
It might be a good idea just to post it under a MAOI food list thread or something easily searchable so others who have questions like Roslynn's can easily find it. I know I lost my good list and have been looking for a good one (one that doesn't still ban mozzarella cheese and other outdated things)
Posted by Phillipa on July 18, 2010, at 19:58:07
In reply to Re: To Roslynn » jade k, posted by inanimate peanut on July 18, 2010, at 19:45:43
So many bipolars at one time or another discontinue their lithium my deceased ex-father in law was one and he'd go into mania and then depression really bad. But each time this happened his lithium when restarted after a while did kick in and work again. Phillipa
Posted by jade k on July 18, 2010, at 20:06:47
In reply to Re: To Roslynn » jade k, posted by inanimate peanut on July 18, 2010, at 19:45:43
> It might be a good idea just to post it under a MAOI food list thread or something easily searchable so others who have questions like Roslynn's can easily find it. I know I lost my good list and have been looking for a good one (one that doesn't still ban mozzarella cheese and other outdated things)
BEER! :-)
Good idea. Roslynn, assuming you're not going to need this asap, I'll post it as a new thread with your name on it tonight or tomorrow.
Take care,
~Jade
Posted by Willful on July 18, 2010, at 22:31:46
In reply to Re: Lou's reply, posted by nadezda on July 18, 2010, at 17:20:11
Could you give me some more recent cites to articles in English, from the US and the UK, that studied the combination of tricyclics and maois?
I'd be interested in contacting and further investigating the efficacy of the combination, which for me would only be possible with more recent, english language citations.
thanks a lot,
Willful
Posted by inanimate peanut on July 19, 2010, at 1:56:00
In reply to Re:articles on tricylic and maoi--, posted by Willful on July 18, 2010, at 22:31:46
Like everything on MAOIs, no one does the research anymore. What big pharma company is going to fund either MAOI or TCA research at this point?
Posted by inanimate peanut on July 19, 2010, at 1:58:35
In reply to Re:articles on tricylic and maoi--, posted by Willful on July 18, 2010, at 22:31:46
Well, the lunesta alone doesn't work. I slept very lightly for 3 hours. Now I'm up typing to you at 2am while I wait for the ambien to kick in.
Posted by Phillipa on July 20, 2010, at 0:44:06
In reply to back to sleeplessness, posted by inanimate peanut on July 19, 2010, at 1:58:35
EST and haven't even gone to bed now what about changing your sleeping schedule and be a dummy like me? Just kidding. Peanut go slow on the sleep meds okay? Phillipa
Posted by kirbyw on July 20, 2010, at 21:16:37
In reply to HELP! NO SLEEP DRIVING ME CRAZY!, posted by inanimate peanut on July 16, 2010, at 19:59:34
I was always skeptical of herbal products, considering the severity of my depression.
but I decided to try Melatonin two weeks ago.
The difference is dramatic. my average sleep duing the hours from 11 pm - 7 am is about 7, before Melatonin it was less 4. worth a try.
Rick
Posted by europerep on July 21, 2010, at 8:05:38
In reply to Re:articles on tricylic and maoi--, posted by Willful on July 18, 2010, at 22:31:46
it's true what peanut said, there will hardly be any new studies on this subject.. you might find case reports at pubmed or other scientific databases, but in general one might well say: no news is good news! had there been numerous deaths due to these combinations, one would find publications on that...
Posted by inanimate peanut on July 22, 2010, at 22:36:39
In reply to Re:articles on tricylic and maoi--, posted by Willful on July 18, 2010, at 22:31:46
I found you one! I found you one! Well, ok, it just says they don't cause serotonin toxicity, but that's better than nothing...
Biological Psychiatry Volume 59, Issue 11, Pages 1046-1051 (1 June 2006)
A Review of Serotonin Toxicity Data: Implications for the Mechanisms of Antidepressant Drug ActionP. Ken Gillman
Received 22 June 2005; received in revised form 9 November 2005; accepted 10 November 2005. published online 06 February 2006.Data now exist from which an accurate definition for serotonin toxicity (ST), or serotonin syndrome, has been developed; this has also lead to precise, validated decision rules for diagnosis. The spectrum concept formulates ST as a continuum of serotonergic effects, mediated by the degree of elevation of intrasynaptic serotonin. This progresses from side effects through to toxicity; the concept emphasizes that it is a form of poisoning, not an idiosyncratic reaction. Observations of the degree of ST precipitated by overdoses of different classes of drugs can elucidate mechanisms and potency of drug actions. There is now sufficient pharmacological data on some drugs to enable a prediction of which ones will be at risk of precipitating ST, either by themselves or in combinations with other drugs. This indicates that some antidepressant drugs, presently thought to have serotonergic effects in animals, do not exhibit such effects in humans. Mirtazapine is unable to precipitate serotonin toxicity in overdose or to cause serotonin toxicity when mixed with monoamine oxidase inhibitors, and moclobemide is unable to precipitate serotonin toxicity in overdose. Tricyclic antidepressants (other than clomipramine and imipramine) do not precipitate serotonin toxicity and might not elevate serotonin or have a dual action, as has been assumed.
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